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Ann Thorac Surg 2006;81:1153-1161
© 2006 The Society of Thoracic Surgeons

Review

Chronic Ischemic Mitral Regurgitation: Repair, Replace or Rethink?

Michael A. Borger, MD, PhD * , Asim Alam, BS, Patricia M. Murphy, MD, Torsten Doenst, MD, PhD, Tirone E. David, MD

Division of Cardiovascular Surgery and Department of Anesthesia, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada

* Address correspondence to Dr Borger, Division of Cardiovascular Surgery, Toronto General Hospital, 4N-451, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada (Email: michael.borger{at}uhn.on.ca).

Ischemic mitral regurgitation (IMR) is a common complication of coronary artery disease and is the focus of a rapidly increasing amount of research. Mechanistic studies have determined that IMR is caused by apical displacement and tethering of the mitral valve leaflets after myocardial infarction, resulting in incomplete coaptation. Despite the relatively high prevalence of IMR, most centers have only a small surgical experience with this disorder. The result is that a number of different procedures have been recently developed without clear improvement in patient outcomes. The current review will examine the myriad surgical options for IMR with a focus on clinical outcomes.




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